Takai Hirokazu, Kiyota Katsuhiko, Nakane Nobutake, Takahashi Tomoki
Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Yamamuro, Kitaku, Kumamoto 860-8518, Japan.
J Orthop Case Rep. 2016 Nov-Dec;6(5):92-95. doi: 10.13107/jocr.2250-0685.650.
Only a few reports have described calcaneus fractures after total knee arthroplasty (TKA). Therefore, in this report, we describe a case of calcaneal avulsion fracture that occurred 5 weeks after a TKA in a relatively young male patient with syphilis.
A 63-year-old man with syphilis had Charcot joint of the right knee. The patient developed severe varus deformity and contracture and experienced severe pain in the knee. TKA was performed to alleviate the pain and improve the patient's gait. The patient noticed slight heel pain 4 weeks after the TKA, and a calcaneus avulsion fracture in the ipsilateral foot was diagnosed without any trauma 1 week later. Open reduction internal fixation was performed with cannulated cancellous screws and a cerclage wire. 3 weeks after the surgery, partial weight bearing was permitted in an orthotic device. Full weight-bearing was allowed at 7 weeks after surgery. The surgical wounds healed without complications. The calcaneus fracture successfully achieved bone union with appropriate surgical intervention and aftercare.
The previous studies have shown that calcaneus stress fracture may occur in elderly osteoporotic women after TKA. Patients with peripheral neuropathy may develop a Charcot fracture after minimal trauma because of decreased protective sensation, even if the patient is a relatively young man without osteoporosis. Charcot joint disease is also considered to be a risk factor for calcaneal stress fracture and Charcot fracture after TKA.
仅有少数报告描述了全膝关节置换术（TKA）后跟骨骨折的情况。因此，在本报告中，我们描述了一例在TKA术后5周发生的跟骨撕脱骨折病例，患者为一名患有梅毒的相对年轻男性。
一名63岁患有梅毒的男性患者右膝关节患有夏科氏关节病。患者出现严重的内翻畸形和挛缩，膝关节疼痛剧烈。为缓解疼痛并改善患者步态，实施了TKA手术。TKA术后4周患者注意到轻微的足跟疼痛，1周后在同侧足部诊断出跟骨撕脱骨折，且无任何外伤史。采用空心松质骨螺钉和环扎钢丝进行切开复位内固定。术后3周，允许在矫形装置中部分负重。术后7周允许完全负重。手术切口愈合良好，无并发症。通过适当的手术干预和术后护理，跟骨骨折成功实现骨愈合。
先前的研究表明，TKA术后老年骨质疏松女性可能发生跟骨应力性骨折。即使患者是相对年轻且无骨质疏松的男性，由于保护性感觉减退，周围神经病变患者在受到轻微创伤后也可能发生夏科氏骨折。夏科氏关节病也被认为是TKA术后跟骨应力性骨折和夏科氏骨折的危险因素。
